More than skin deep?

A 46 year old man was admitted with a 6 week history of nausea, vomiting, and night sweats, and a weight loss of 2 stone (12.7 kg). His medical history included excision of a malignant melanoma (Breslow’s thickness 1.6 mm) from the left side of his neck 12 months earlier. There was no evidence of local recurrence, or lymphatic or metastatic spread, 6 months after resection. The patient did not smoke. Clinical examination was unremarkable. Initial investigations demonstrated mild leucocytosis, neutrophilia, and thrombocytosis. Contrast enhanced computed tomography of the abdomen (fig 1⇓)and barium enhanced radiography of the small bowel (small bowel follow through; fig 2⇓) were performed. Fig 1 Computed tomography scan of the patient’s abdomen Fig 2 Radiograph of the patient’s small bowel ### 1 What are the different types of malignant melanoma? #### Short answer The different types of melanoma are superficial spreading melanoma, lentigo maligna, acral lentiginous melanoma, and nodular melanoma. #### Long answer Melanomas fall into four basic categories. Superficial spreading melanoma is by far the most common type, accounting for about 70% of all cases of melanoma. This type of melanoma is seen most often in young people. It has the appearance of an irregular, flat, or slightly raised discoloured pigmented lesion, although the colour can vary between tan, brown, black, red, blue, and white. This type of melanoma can develop in a previously benign mole anywhere on the body, most likely on the trunk in men and the legs in women. Lentigo maligna usually appears as a flat or mildly elevated mottled tan, brown, or dark brown discoloured plaque. This type of in …